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Cataract surgery rationing on the rise

NHS commissioners are ignoring clinical guidelines by
rationing access to cataract surgery, an investigation by The BMJ has
found.

NICE’s guidelines state that cataract removal is cost
effective and should not be restricted to the more severe cases.

However, in 2018-19 more than a fifth (22%) of patients
in England who needed cataract surgery were screened, three times the
proportion of 7% in 2016-17.

Among the 185 CCGs that provided data, the investigation
found that almost 2,900 prior approval requests or individual funding requests
for cataract surgery were rejected last year, more than double the number two
years ago.

Although the proportion of prior requests for cataract
surgery being rejected has fallen since 2016-17, the absolute number is rising.

The investigation follows research by the Medical
Technology Group, a coalition of patients’ groups, research charities and
device manufacturers, which found that over half of CCGs in England included
cataracts in lists of treatments they deemed to be of “limited clinical value.”

Mike Burdon, president of the Royal College of
Ophthalmologists, told The BMJ the findings showed that commissioners were
ignoring NICE guidelines.

“Health economists spent 18 months reviewing the evidence
for cataract surgery on both first eye and second eye, and they convincingly
concluded that there was no justification to ration cataract surgery on the
basis of acuity,” he argued.

Graham Jackson, co-chair of NHS Clinical Commissioners,
said ensuring patients get the best possible care and outcomes against a
backdrop of spiralling demands, competing priorities and increasing financial
pressures is one of the biggest issues CCGs face.

“Cataract surgery specifically is an area that is often
subject to prior approval,” he stated. “Such clinical decisions are critical in
deciding when a patient has reached the stage that an operation will be the
best option.”

A Department of Health and Social Care spokesperson added
that clinicians were the right people to decide when or whether a patient
should have a procedure.”